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PubMedDate not supplied

Relationship between bone mineral density of the proximal femur and strength of hip muscles in postmenopausal women.

The relationship between muscle strength and bone density is well known, but only a limited number of studies relating muscle strength to bone mineral density of a site-specific limb have been performed. The main purposes of this study were as follows: (1) to assess the relationship between the strength of hip muscles and bone mineral density of the proximal femur in 100 postmenopausal women; (2) to compare strength values of three subgroups, which were formed on the basis of the femoral neck Z-scores. By using an isokinetic dynamometer (Cybex 350), muscle strength tests were performed for hip muscles and bone mineral density measurements were obtained by dual energy x-ray absorptiometry. Statistical analysis demonstrated a moderately positive correlation between bone mineral density of the femoral neck and hip muscle strength (with abductors: r = 0.267, P = 0.008; with adductors: r = 0.276, P = 0.007). A moderate correlation was also found between bone mineral density of Ward's triangle and hip adductors (r = 0.327; P = 0.001). When muscle strength mean values of subgroups were compared with each other, there was no statistically significant differences. These data may suggest that the isokinetic strength of hip muscles may not contribute to the bone mineral density of the proximal femur.

Adult↗
PubMed2004

The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station.

OBJECTIVE: To compare the inter- and intrarater reliability of a portable dynamometer anchoring station (DAS) to a handheld dynamometer (HHD). DESIGN: Repeated-measures design. SETTING: Human performance and movement analysis laboratory. PARTICIPANTS: Fifteen healthy participants, ages 23 to 44 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three consecutive measures of peak bilateral isometric strength were obtained for hip abduction, extension, and flexion by 2 investigators by using the DAS and the HHD after a 1-hour rest period. This testing scenario was repeated 1 week later. Intraclass correlation coefficients (ICCs) were used to determine reliability. RESULTS: Interrater ICCs of average peak strength ranged from.84 to.92 (hip flexors),.69 to.88 (hip abductors), and.56 to.80 (hip extensors). Intrarater ICCs ranged from.59 to.89 for tester A and from.72 to.89 for tester B using the DAS, and from.67 to.81 for the HHD across muscle groups. CONCLUSIONS: The DAS showed good intrarater reliability for hip flexion and abduction, whereas the HHD demonstrated higher reliability for hip extension. The results support the use of dynamometers that are quick and reliable and that reduce tester bias during hip strength assessment.

Adult↗
PubMed2006

The development, validity, and reliability of a manual muscle testing device with integrated limb position sensors.

OBJECTIVE: To report the development and validation of a new hand-held muscle strength-testing device that is integrated with orientation sensors and designed to test the strength of major muscle groups at a given limb or joint position. DESIGN: Design description and validation study. SETTING: University-based human movement facility. PARTICIPANTS: Twenty-eight able-bodied, healthy subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: A device was developed based on a hand-held force dynamometer with integrated orientation sensors. The validity and reliability (interrater, intertrial) of 5 maximum isometric contractions of hip flexion, knee extension, and ankle plantarflexion and dorsiflexion were assessed. The results were compared with those from an isokinetic dynamometer (KinCom). RESULTS: The new manual muscle tester was highly reliable and valid in estimating muscle strength of the lower limbs. The coefficient of variation between trials of all movements was low, with a mean less than 10% (range, 3.7%-8.9%). The only significant difference in muscle strength between the new device and the isokinetic dynamometer was found for hip flexion. CONCLUSIONS: The new hand-held muscle strength tester appears to be a reliable and valid clinical assessment tool that can be used to objectively assess muscle strength at particular limb positions and/or joint angles. This feature appears to represent a technical advance in portable muscle strength devices, providing comparable information to those obtained by isokinetic dynamometers at a fraction of the cost and size. However, the device needs to be validated in clinical populations, such as patients with spinal cord injury and stroke, in order to demonstrate its general clinical utility.

Adolescent↗
PubMed2003

Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair.

Individuals with Parkinson's disease (PD) have difficulties rising from a chair; however, factors contributing to this inability have never been investigated. We compared lower extremity strength between individuals with PD and healthy controls and quantified the relationships between strength and the ability to rise from a chair. Ten men with mild PD and 10 sex- and age-matched controls performed maximal concentric, isokinetic knee and hip extensor torque on an isokinetic dynamometer to quantify muscle strength. Subjects also rose from a chair at their comfortable pace without the use of their arms and the duration of this task provided a measure of sit-to-stand (STS) ability. Subjects with PD were tested in an on- and off-medication state on different days. Mean hip and knee extensor torques were lower in subjects with PD, with greater deficits found at the hip. Greater hip strength was related to better STS ability in subjects with PD while greater knee strength was related to better STS ability in controls. These results show that individuals with mild PD generate smaller extremity forces compared to controls. Reduced strength, particularly at the hip, may be one factor that contributes to the difficulty of persons with PD to rise from a chair.

Antiparkinson Agents↗
PubMed1987

Strength testing with a portable dynamometer: reliability for upper and lower extremities.

This study was designed to determine intraobserver and interobserver reliability of maximal muscle strength for upper and lower extremity muscle groups. Four healthy subjects were tested with a portable muscle dynamometer on two separate occasions by three separate examiners to determine maximal isometric strength of lateral pinch between thumb and index finger, elbow flexion, elbow extension, shoulder flexion, hip flexion, hip extension, hip abduction, knee flexion, and ankle dorsiflexion. A break test was also used to evaluate the strength of cervical flexor muscles and extensor hallucis longus. Pearson correlation coefficients for inter- and intraexaminer testing was good for upper extremity test values from 0.85 to 0.99. The variation coefficient of the methodology error (CV) in all upper extremity muscle tests was between 5.1% and 8.3%. These results seemed reliable for clinical muscle strength testing. However, correlation coefficients for lower extremity testing were poor, with values ranging from -0.20 to 0.96. The CV in these tests was much greater than in the upper extremities and ranged from 11.3% to 17.8%. Both break tests also had high CV, with each being greater than 17%. Our results demonstrate that although the dynamometer is reliable for testing upper extremity muscle groups, it is unreliable for testing lower extremity muscle groups. Further work is needed to evaluate muscle strength quantitatively in the clinical setting in an accurate, valid, and reliable manner.

Arm↗
PubMed2005

Two-year follow-up on joint stability and muscular function comparing rotating versus fixed bearing TKR.

Mobile and fixed bearing in total knee replacement are still discussed controversially. In a retrospective, matched-pair study, we investigated 40 patients with computer-assisted (BrainLAB) primary total knee replacement (PFC Sigma, DePuy) performed two years before. Twenty patients each received a mobile bearing and a fixed bearing. We compared Womac Score, Knee Society Score, postoperative ROM, fluoroscopic measurement of knee stability in flexion and extension and isokinetic muscle strength using a Biodex-3 dynamometer. Both groups showed similar results concerning WOMAC Score (total rotating bearing: 23.05; fixed bearing: 22.57), KSS (rotating bearing: 174.89; fixed bearing: 176.1). Isokinetic muscle force demonstrated statistically significant superior results for knee flexion in the rotating bearing group. Medio-lateral stability revealed statistically significant superior results for the rotating bearing compared to fixed bearing in extension (P>0.05). In flexion only lateral stability was superior (P>0.05). Two-year clinical follow-up after computer-assisted total knee replacement resulted in good clinical outcome with high patient satisfaction. Statistically significant better values for the rotating platform group were found for the medio-lateral stability in extension and the peak flexion torque.

Aged↗
PubMed2005

Reliability of a criterion-based test of athletes with knee injuries; where the physiotherapist and the patient independently and simultaneously assess the patient's performance.

UNLABELLED: A new criterion-based evaluation test method, has been developed in order to assess the functional ability of athletes with knee injuries, 'Tests for Athletes with Knee-injuries' (TAK). The physiotherapist and the patient assess independently and simultaneously the patient's performance. The TAK comprises eight demanding functional activities with emphasis on strength, stability, springiness and endurance. OBJECTIVES: To evaluate the inter-rater and intra-rater reliability of TAK between the physiotherapist's and the patient's assessments. Further, to evaluate the relation between the functional tests in TAK and the isokinetic quadriceps muscle strength. MATERIALS AND METHODS: Fifty-nine subjects were included in the study. Thirty-one were anterior cruciate ligament (ACL) reconstructed, fourteen were ACL-injured not reconstructed and fourteen were healthy athletes. The inter-rater-reliability was evaluated by assessments of 59 subjects carried out by two independent physiotherapists using visual observation. The assessment was rated on a 0-10-point scale according to five elaborate criteria drawn up for each test. Simultaneously, the subjects were asked to rate their own performance on each test using a 0-10-point scale. The intra-rater-reliability of TAK was evaluated by a test-retest of 31 patients. The relation between the physiotherapist's and the patients' ratings as well as of the patients' ratings at two different occasions were evaluated. Isokinetic quadriceps muscle strength was measured in a Biodex dynamometer on all 59 subjects in order to study the relation between quadriceps muscle strength and the results of the functional tests in TAK. RESULTS: Inter-rater-reliability showed good consistency between the assessments of the two physiotherapists in seven of eight tests (kappa = 0.62-0.78). The intra-rater-reliability was moderate to good (kappa = 0.43-0.65) in the test-retest study. The consistency of the physiotherapist and the patients' assessments differed, but showed good correlation. The consistency of the test-retest study of the patients' assessment was low. The correlation between the isokinetic quadriceps muscle strength measured in a Biodex dynamometer and the results of the functional tests was moderate in this study. CONCLUSIONS: This criterion-based test method for athletes with knee injuries showed good inter-rater reliability and acceptable intra-rater reliability for the physiotherapists' assessment. The consistency of the patients' ratings was low. The correlation between isokinetic quadriceps muscle strength and functional tests in TAK was moderate. The validity has not been evaluated in this study but will be done in the future.

Adolescent↗
PubMed2006

A method for comparing manual muscle strength measurements with joint moments during walking.

This paper describes a protocol for dynamometer assisted manual muscle testing of the major muscle groups of the lower extremity and its application to 11 able-bodied children who also had conventional gait analysis to obtain joint kinetics. Data from the manual muscle testing was processed in such a way that the results for maximum muscle strength (grade 5) and resistance against gravity alone (grade 3) were presented in Nm/kg allowing direct comparison with conventional joint kinetics. The strength measurements of the hip muscles and the knee extensors were between two and three times the moments exerted during normal walking. Those of the knee flexors and dorsiflexors were about five times the joint moments. Measured plantarflexor strength was only just greater than the moment exerted during walking. These results, particularly those for the plantarflexors, question how valid it is to use measures of isometric muscle strength as indicators of muscle function during activity. The study also compares grade 3 muscle strength with both grade 5 strength and the maximum joint moments. For all muscle groups tested grade 3 muscle strength was less than the maximum moment exerted during normal walking. For the plantarflexors it was less than 1% of that moment. The study demonstrates that reliable isometric muscle testing is possible in able-bodied children but requires considerable care and is time consuming. More work is required to understand how measurements made in this way relate to how muscles function during activity.

Biomechanical Phenomena↗
PubMed2001

The effect of hand-grip stabilization on isokinetic torque at the knee.

Isokinetic dynamometers commonly measure muscle strength during conditioning and rehabilitation. Previous studies have shown that stabilization can affect isokinetic torque production. However, the effect of stabilization with hand-grip use has not been examined, and there are inconsistencies in the literature regarding its use. Fifteen men (mean age +/- SD = 24 +/- 3 years, height = 187 +/- 6 cm, mass = 84 +/- 10 kg) and 15 women (age = 25 +/- 4 years, height = 167 +/- 8 cm, mass = 62 +/- 6 kg) were tested on a Cybex 6000 dynamometer. Torque and joint angle signals, as well as quadriceps and hamstrings electromyographic (EMG) signals, were recorded during maximal knee flexion/extension at speeds of 60, 180, and 300 degrees x s(-1). Subjects performed the testing both with (stabilized) and without (nonstabilized with arms folded across the chest) hand-grip use. Repeated-measures analysis of variance (ANOVA) revealed a significant-motion (flexion, extension), X-condition (stabilized, non-stabilized) interaction in the data from the men in which hand-grip stabilization resulted in an 8.4% increase in knee extensor torque vs. a 0.2% increase in knee flexor torque. Stabilization did not significantly affect torque in women. The EMG analyses did not indicate a significant change in either agonist drive or antagonist cocontraction that accounted for the enhanced torque output with hand-grip use. This study found that hand-grip use enhanced knee extension maximal torque in men, but did not affect torque in women. The EMG data did not account for the changes in the torque data. Differences between men and women may have been due to mechanical factors and grip strength. These results indicate that hand-grip use needs to be considered when examining gender differences in knee strength and when studying knee flexion-extension ratios.

Adult↗
PubMed2003

Do pre-operative abdominal exercises prevent post-operative donor site complications for women undergoing DIEP flap breast reconstruction? A two-centre, prospective randomised controlled trial.

The deep inferior epigastric perforator (DIEP) flap is the gold standard for breast reconstruction using abdominal tissue. Unlike the transverse rectus abdominis myocutaneous (TRAM) flap, no rectus abdominis muscle is removed with the flap, but intra-muscular scarring can still cause post-operative complications. Strong abdominal muscles have been advocated as a prerequisite for surgery, but without any evidence as to the potential benefits. This study aimed to investigate the effect of pre-operative abdominal exercises on inpatient pain levels, length of hospital stay, post-operative abdominal muscle strength and function following a DIEP flap.Ninety-three women undergoing delayed breast reconstruction with a DIEP flap between October 1999 and November 2000 were randomly allocated to either a control or exercise group. The exercise group performed pre-operative exercises using the Abdotrim abdominal exerciser. Pre-operatively, outcome measures included trunk muscle strength measured on an isokinetic dynamometer, SF-36, rectus muscle thickness measured using ultrasound, and submaximal fitness. Post-operative pain and length of hospital stay were recorded. Subjects were reassessed using the same outcome measures 1 year post-operatively. There was a statistically significant increase in static (isometric) muscle strength and thickness pre-operatively for the exercise group. One year following surgery, there was a significant decrease in dynamic (concentric and eccentric) flexion strength for both groups, although the clinical significance of this is questionable as the majority of women had returned to pre-operative fitness and the surgery had no impact on functional activities. The static flexion strength of the control group was reduced at 1 year, whereas it was maintained in the exercise group, although this was not statistically significant. One third of women in the control group complained of functional problems or abdominal pain post-operatively compared to one fifth of the exercise group. Overall, the DIEP flap had no major impact on abdominal muscle strength for either group, demonstrating its superiority over the TRAM flap. There was no statistically significant benefit to the exercise group of the pre-operative exercises 1 year following surgery. However, there was a subjective benefit, albeit statistically nonsignificant, in terms of reduced functional problems post-operatively and improved well-being prior to surgery.

Abdominal Muscles↗
PubMed1986

The influence of color and demand characteristics on muscle strength and affective ratings of the environment.

Demand characteristics may influence claims that the color pink inhibits muscle strength whereas blue increases muscle strength. In Experiment 1, undergraduates (N = 59; 30 women, 29 men) were told either that the experimenters thought pink would increase and blue decrease strength or that blue would increase muscle strength and pink decrease muscle strength. A hand dynamometer assessed grip strength as subjects stared at each of 8 differently colored panels. Results indicated that men viewing the pink or orange panels had higher grip strength under pink-strengthen than under pink-weaken instructions. The reverse relationship was found for men viewing a green panel. For women, the pink-weaken instructions resulted in a higher grip strength than did the pink-strengthen instructions, regardless of actual color present. In Experiment 2, women in a no-instruction control condition had lower grip strength than women given the pink-weaken instructions. For men, the control (no-instruction) condition resulted in higher grip strength than the pink-weaken condition. Results of both studies suggest that men followed overt demand characteristics but that women reacted with increased intensity to any suggestion that a stereotypically feminine pink is associated with weakness.

Adult↗
PubMed1988

Electromyographic and dynamometric characteristics of female pelvic-floor musculature.

The purpose of this study was to determine whether differences existed on dynamometer recordings of muscle strength and electromyographic activity of the pelvic floor in 5 pregnant and 10 nonpregnant women. Pelvic-floor musculature strength measurements, using a perineometer, showed no significant differences between groups. All subjects could hold maximal voluntary contractions for three seconds, but pelvic-floor strength measurements decreased rapidly beyond three seconds. Integrated electromyographic recordings failed to show significant differences between groups. A periodicity of integrated electromyographic activity was observed in both pregnant and nonpregnant subjects. Great variability in the amount of integrated electromyographic activity was observed among both groups during maximal voluntary contractions. The practice of requesting that individuals with pelvic-floor dysfunction hold maximal voluntary contractions longer than three seconds may not be efficacious. Electromyographic measures must be complemented by strength measures for adequate evaluation and treatment of pelvic-floor dysfunction.

Adult↗
PubMed2003

Cervical muscle strength after laminoplasty.

To determine changes in cervical muscle strength after laminoplasty and to evaluate the relation between muscle strength and neck pain, we measured maximum isometric muscle strength using a handheld dynamometer. We also investigated neck pain before surgery and every month after surgery in 21 subjects who had undergone French-door laminoplasty. Muscle strength decreased particularly 1 month after surgery, the extensor muscles being affected more than the flexors. The strength of both muscle groups increased gradually; and at 1 year after surgery they had regained their presurgical status. All of the subjects complained of severe neck pain after 1 month. Their complaints began to decrease a few months after surgery, although they were still present in nine patients at 1 year after surgery. The correlation between muscle strength and neck pain was strongly negative for extension and flexion in men and for extension in women. No correlation was found between flexor muscle strength and neck pain in women. The extension/flexion ratio was significantly high in the neck pain group 1 year after surgery. Our results suggest that symptoms within a few months after surgery are due to surgical trauma to the soft tissues but that chronic neck pain derives from an imbalance of the two muscle strengths.

Aged↗
PubMed2002

Muscle performance in patients with fibromyalgia.

OBJECTIVES: To compare muscle performance in women with fibromyalgia and in healthy women. PATIENTS AND METHODS: Sixteen women with fibromyalgia syndrome (FMS) and 85 healthy women who were physically inactive or engaged in recreational sports underwent measurements of four parameters: maximal concentric isokinetic muscle strength of the knee extensors and flexors in the dominant limb, isometric grip strength on a Colin dynamometer, muscle fatigue resistance during 30 maximal concentric isokinetic contractions of the dominant knee flexors and extensors at 180 degrees angular velocity, and static endurance during posture maintenance. RESULTS: All muscle variables were decreased in the FMS patients as compared to the controls. The decreases were more marked during aerobic than during anaerobic exercise. Mean decreases were 39% (P<0.001) for muscle strength, 40% (P<0.0001) for fatigue resistance, and 81% (P<0.0001) for static endurance. Pain during exercise as evaluated using a visual analog scale was more marked in the FMS patients. CONCLUSION: This study of the three pathways supplying energy to muscle confirms that muscle function is globally impaired in FMS patients. The results suggest that the impairment predominates on aerobic processes.

Adult↗
PubMed2003

Muscle strength in patients with chronic pain.

OBJECTIVE: To analyse the influence of chronic pain on muscle strength. DESIGN: Muscle strength of patients with unilateral nonspecific chronic pain, in an upper or lower limb, were measured according to a standardized protocol using a hand-held dynamometer. Before and after muscle strength measurement, a visual analogue scale for pain intensity was assessed. RESULTS: Forty patients were measured and the muscle strength of the painful side was 20-30% less than that of the nonpainful side. Strength reduction was seen in the whole limb. A significant correlation between pain intensity and reduced muscle strength in the painful limb existed for hip flexion, knee flexion, knee extension and three-point grip. CONCLUSIONS: A strength reduction of 20-30% in a painful limb seems to be 'normal' in chronic pain patients.

Adult↗
PubMed1981

Isokinetic thigh muscle strength after ligament reconstruction in the knee joint: results from a 5-10 year follow-up after reconstructions of the anterior cruciate ligament in the knee joint.

We evaluated the thigh muscle strength using an isokinetic dynamometer in 80 patients 5 to 10 years following anterior cruciate ligament reconstruction. Patients with good results also had good muscle function, both of their flexor and their extensor muscles. Patients with poor results demonstrated reduced muscle strength in both their hamstrings and their quadriceps. Patients with fair functional results demonstrated reduced strength of their extensor muscles compared to their normal leg. However, strength in their operated leg's flexor muscles was unchanged compared to their normal leg. This may be due to the fact that strong hamstring muscles can compensate for some instability of the anterior cruciate ligament.

Adolescent↗